A pilot study to evaluate the impact of involving breast cancer patients in the multidisciplinary discussion of their disease and treatment plan

Multidisciplinary care is the accepted best model of management of breast cancer patients. Current evidence suggests that multidisciplinary care has the potential to reduce mortality, improve quality of life, and reduce health care costs. We investigated the impact of patient involvement in the multidisciplinary meeting. A pilot study was conducted to assess the feasibility and acceptability of directly involving patients diagnosed with breast cancer in multidisciplinary clinic discussions and treatment planning. 30 consecutive breast cancer patients presenting for surgery were invited to attend our weekly multidisciplinary breast meeting at the time of receiving their results of surgery. Patients completed questionnaires before and after the meeting, and participated in a tape-recorded interview with the breast care nurse after the meeting. Members of the multi-disciplinary team also completed a short survey at the end of the study. The intervention was highly valued by most of the participating patients; and acceptable to and welcomed by most health professionals in the multidisciplinary team. Change in anxiety scores was not affected by participation. Patient attendance at the breast multidisciplinary meeting was shown to be potentially acceptable to both patients and health professionals, without unduly raising patient anxiety. A national survey exploring attitudes towards patient involvement in the multidisciplinary team meeting is currently in progress.

Measures of health-related quality of life and functional status in survivors of oral cavity cancer who have had defects reconstructed with radial forearm free flaps

The aim of this study was to evaluate (by postal questionnaire) quality of life and function in patients who have had resections of oral cancer and reconstruction by radial forearm flaps. Between October 1987 and December 2002, 258 patients had reconstructions by radial forearm flaps after resection of tumours in the oral cavity. Of these, 139 surviving patients were identified from the database and were sent questionnaires comprising five sections: Functional Assessment of Cancer Therapy-General (FACT-G) and -Head and Neck (FACT-HN); University of Washington Quality of Life Scale (UWQoL); Performance Status Scale for Head and Neck Cancer (PSS-HN); and the final section addressed dental rehabilitation and morbidity at the donor site. Sixty-three questionnaires (45%) were returned. In 17 (27%), parts of the questionnaire were incomplete. The median UWQoL score was 623/900, FACT-G was 92/108, FACT-HN was 31/48, and PSS-HN showed that eating in public, understandability of speech and normality of diet were 75/100, 75/100 and 50/100, respectively. The effect of stage and site on quality of life and function did not reach statistical significance. The effect of radiotherapy on speech (p=0.036) and diet (p=0.007) was significant. Patients who worried about their cancer returning had a lower UWQoL score (p=0.016). Ninety percent regarded their arm as disfigured, but 81% felt comfortable wearing short-sleeved shirts. Sensation and function of the hand were reported as normal in 87 and 92%, respectively. We conclude that patients who have had oral cancer have a persistent reduction in quality of life and function long after completion of treatment. The effects can be assessed by postal questionnaire, but the low rate of return (45%) and difficulties with completion reduce the quality of the data. Quality of life and function are essential components of improvements in outcome.

Clinical outcome and technical aspects of 263 radial forearm free flaps used in reconstruction of the oral cavity

BACKGROUND

The aim of this study was to report the applications, complications, and limitations of the radial forearm flap when used for reconstruction after excision of cancers in the mouth.

PATIENTS AND METHODS

We reviewed records in our database from October 1987 to December 2002; a total of 505 patients had surgical defects of the head and neck reconstructed with a radial forearm flap: 258 patients had oral cancers, of whom 173 were men and 85 women, median age was 70 years. Five patients had two reconstructions (total 263), of which 247 were fasciocutaneous and 16 osseofasciocutaneous flaps. Mucosal squamous carcinoma accounted for 97% of the primary cancers.

RESULTS

There were nine failures of the flap (3.4%) and four episodes of partial necrosis. Four patients (2%) died within 30 days of operation. Orocutaneous fistulas appeared in nine patients (3.4%), 10 patients had wound infections, and nine had haematomas. The nine failed flaps were replaced by a second free flap in one patient, a pectoralis major flap in three, a buccinator myomucosal flap in one, a skin graft in one, and the remaining three defects healed by secondary intention. There was one failure and one partial failure among the 16 osseofasciocutaneous flaps.